Producer Handler Report of Receipts & Utilization

UNITED STATES DEPARTMENT OF AGRICULTURE
1325 lnduslrial Parkway Norlh

Agr¡cultural Marketing Service - Dairy Programs

P.O. Box 5102

MIDEAST MARKETING AREA

Brunsw¡ck, Ohio 442'12

Federal Order No. 33

Phone: (330) 225-4758
Toll Free: (888) 751-3220

Fax: (330) 220-6675

Form aooroved. OMB 0581-0032

d. Fa¡lure to report can result ¡n lhe assessment of a c¡v¡l penalty
of up to $1,000 per day (7 U.S.C. 608c(14X8)) or, upon conv¡ction, in a fine of up to $5,000 per day (7 U.S.C. 608c (14X4)).

This report ¡s requ¡red by lhe order ¡n accordance w¡th 7 U.S.C. ô08c and

PRODUCER HANDLER REPORT OF RECEIPTS AND UTILIZATION
Month and Year
Plant Location and Mail¡ng Address

TOTAL RECEIPTS FROM ALL SOURCES
TOTAL TO BE ACCOUNTED FOR
Butterfat
Pounds

Sales to

Plants: (indicate name & location of

Skim & Cream Used to Produce:

(excess line 8 over line
I

declare under the penallies prov¡ded by law that lh¡s report has been examined by me and to the best of my knowledge and bel¡ef ¡s a true, corect, and complete report.
I also

cerlify that I am authorized to sign this report

Signature
Date

Tifle
(Owner, Partner or Officer)

According to the Papenruork Reduction Act of 1995, an agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this
information collection is 0581-0032. The time required to complete this information
collection is estimated to average 0.5 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs
and activities on the basis of race, color, national origin, age, disability, and where
applicable, sex, marital status, familial status, parental status, religion, sexual
orientation, political beliefs genetic information, reprisal, or because all or part of an
individual's income is derived from any public assistance program. (Not all prohibited
bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should
contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a
complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office
of the Assistant Secretary for Civil Rights, 1400 lndependence Avenue, S.W.,
Washington, D.C. 20250-9410, or call (866) 632-9992 (English) or (800) 877-8339
(TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federalrelay). USDA is an equal opportunity provider and employer.